فصلنامه بیهوشی و درد
سال چهارم شماره 1 (پاییز 1392)

Aim and Effective postoperative pain control is very important. Paracetamol is a non-opioid analgesic drug with less side effects. At this study، we compare analgesic effect of paracetamol plus meperidine and meperidine alone on postoperative cesarean. Methods and Materials: This double blind randomized clinical trial was conducted on 70 pregnant undergoing elective cesarean section under Spinal Anesthesia. They were randomly divided into two equal groups. The first group received 1g intravenous Paracetamol، and the 2nd group received 25 mg intravenous meperidine15 minutes before the end of operation. The first group received infusion of 100 ml (1gr) paracetamol and the 2nd group received 100 ml normal saline at 6،12 and 18 hours after the end of operation. Patients’ pain assessment based on Visul Analogue Scales was done every 2 hour for 6 hours and then every 6 hour till 24 hours and recorded. When the patients’ VAS was more than 3، Meperidine (25 mg) was administrated. Time to first Meperidine injection after operation and the amount of meperedine was recorded. Time to the first Meperidine injection after operation was hours in Meperidine group and hours in Paracetamol group (p=0. 005). Number of injections and total Meperidine dose in Paracetamol group was significantly lower than another group (p<0. 001). Paracetamol has a powerful analgesic effect on post cesarean section pain and reduced total dose of Meperedin significantly.

Aim and Thoracotomy is one of the most painful operations and many attempts have been done to provide analgesia after surgery to make convenience for the patient and prevent from major complications too. Intercostal cryoanalgesia، local anesthetic drugs administration through intrapleural catheter، intravenous or epidural opioid administration are some applied methods. In this study there is a comparison in level of analgesia after thoracotomy between intrapleural bupivacaine and cryoanalgesia، and also the influence of these 2 methods on prevention of FEV1 and FVC reduction is investigated. Methods and Materials: This clinical trial study was performed on 50 patients in ASA Class I، II which were among 20 to 70 years old and candidate for elective thoracotomy and divided into 2 groups randomly (each groups were consisted of 25 patients). In the first group، 40ml 0. 25 percent bupivacaine was administered per each 6h through intrapleural at the end of surgery. In the second group، at the end of operation cryoanalgesia was performed to intercostals nerves، at the level of incision، 2 cranial and 2 caudal. Pain score of the patients was recorded during 24 hours post operation on the base of visual analogue score (VAS). If the patient is needed more analgesia، 30mg intravenous meperidine was administrated and it was recorded. Every patient underwent spirometery before surgery and also 48h and one week post operation. The data was analyzed by spss software and T-test and Mann-whitney test at the end. The difference between data on every point with p<0. 05 considered significant. There was a significant difference between the two groups in meperidine requirements (P=0/033). But there was no significant difference in post operation pain score and rate of improvement in FEV1 and FVC between 2 groups. Also there was no significant difference between two groups in rate of FVC and FEV1 depended on the type of operation. Our study showed that rate of meperidine requirements for supplementary analgesia in intrapleural bupivacaine group is less than cryoanalgesia group. But there is no significant difference between groups in pain score and of FEV1 and FVC، and it is not possible to make an assessment because of sample insufficiency and it is needed to be more investigated.

Aim and Abdominal surgeries are usually very painful post-operatively for the patients; consequently pain control would lead to a more rapid recovery period in patient and it would lower the complication rate. Nowadays intravenous Acetaminophen is one of the most prevalent drugs used in operating rooms to control pain. Ketamine also is an anesthetic drug، being a reasonable analgesic agent. This double blinded RCT has been done to compare the analgesic effect of paracetamol in comparison with ketamine on postoperative pain control after hysterectomy. Methods and Materials: Our patients were randomly allocated into two groups، according to the inclusion-exclusion criteria. The first group (40 patients) recieved 1 gram IV paracetamol and the second group (40 patients) recieved 0. 15 mg per kg ketamine instead. The changes in blood pressure، heart rate، pain based on visual analogue score، and also the sedation Ramsay score were all evaluated at 4،6،12، and 24 hours after the operation. Moreover، nausea-vomiting and the amount of consumed analgesics were recorded and compared between the two groups According to our findings، the VAS scoreand the total analgesic use were both significantly less in the Acetaminophen group in comparison with the ketamine group. However there was no significant difference found in regards to sedation score، nausea-vomiting، and respiratory problems. (p> 0. 05) Prescribing paracetamol at the end of abdominal hysterectomy is significantly more effective for pain control than intravenous ketamine.

Aim and The aim of the present study was to determine the effectiveness of (Mindfulness-Based Stress Reduction) MBSR on quality of life in patients with Chronic Low back Pain (CLBP). This research was conducted by using semi- experimental study with pretest-posttest design، using control group. So، from Patients with chronic back pain who appointed the Pain clinics in Tehran، 18 patients were selected and randomly allocated into two equal experimental and control groups. The Short Form Health Survy (sf 36) questionnaire was completed by subjects before and after the intervention. The results of this research using Mann-Whitney Test showed that the mean Quality of Life in experimental group had increased significantly in comparison with the control group. According to our findings، the Mindfulness-Based Stress Reduction Therapy leads to improvement of Quality of Life and use of coping strategie with pain in patients with chronic low back pain (CLBP).

Aim and Pain is one of the factors that produce after of decrease or opiates stop. The purpose of this study was to determination the effect of exercise training on evoking of Hypoalgesia effect subsequent of increased BEND levels in the addicts. Methods and Materials: In this study، 20 male addicts (20-33 years old) were selected after public call and divided into drug supplement (N=10) and exercise -drug supplement (N=10) groups. The first group was performed exercise training to intensity of 70-75 percent of VO2max for twenty sessions (5 sessions per week and for 45 to 55 minutes in each session). They also was consumption 10 milligrams Methadone. The second group only was consumption 10 milligrams methadone daily. After it we survey β- Endorphin levels and hypoalgesia due to mechanical pain and pain due to decrease and increase of temperature. Statistic analysis was shown that the amounts of BEND significantly increase in both groups (P<0. 05). Also، the first group significantly enhanced status of hypoalgesia in all of painful stimulus (P<0. 05). Presumably method of exercise-drug supplement is better for decrease and management of pain in addicts.

Aim and Emergence from general anesthesia can be associated with coughing، agitation، and hemodynamic disturbances. Remifentanil may attenuate these response، so we examined the effects of maintaining a remifentanil infusion in the recovery room، on recovery profiles such as coughing and cardiovascular responses after general anesthesia. Methods and Materials: In a prospective، double-blinded، randomized trial، we enrolled 60 adult patients undergoing nasal surgery with remifentanil-based anesthesia. During the emergence phase، the infusion rate of remifentanil was reduced to 0. 02 micro/kg/min in treatment group 1 and to 0. 05 micro/kg/min in treatment group 2، whereas in the control group remifentail was discontinued and placebo was started instead. During emergence، both of the treatment groups had a significantly lower incidence and severity of coughing and slower heart rate. The mean systolic blood pressure (MAP) in the treatment group 2 was significantly lower compared with the other groups، but the awakening or extubation time was prolonged in this group، whereas time interval to awakening and tracheal extubation was similar between the control group and treatment group 1. Maintaining a low-dose remifentanil infusion during emergence did not prolong awakening but reduced heart rate and the incidence and severity of coughing due to the endotracheal tube، whereas high-dose remifentanil infusion reduced the hemodynamic changes and coughing associated with tracheal extubation while significantly delaying the extubation time.

Aim and Awareness during anesthesia is recalling the events that occurred during general anesthesia and surgery. The experience of awareness is emotional trauma that causes a painful and exhausting emotional، and post-traumatic stress. The goal of this study is assesing the incidence of awareness during general anesthesia in patients undergoing surgery at a universitial hospital. Methods and Materials: This was a descriptive study performed in a university hospital affiliated to Tehran University of Medical Sciences. 700 patients more than 18 years old، in good physical condition and cooperative who were able to speak in Persian were enrolled. The participants were interviewed 24 hours after general anesthesia and surgery using a standardized questionnaire. A total of 18 patients (2. 6%) recalled some events between sleeping and waking. 59 (8. 5%) had seen dreams، 19 (2. 7%) had felt pain and 23 patients (3. 4%) had hearing experiences. The only significant correlation between hearing awareness and location of operation، dreams and weight were obtained. The incidence of awareness during general anesthesia in this study is more than reports from other countries.

Aim and Cancer patients require palliative care for reduction of their pain. The purpose of this study was identifying perception of nurses from palliative care of pain in cancer. Methods and Materials: This study done with qualitative approach and using content analysis method. In this study، 15 nurses were selected through purposive sampling and face- to- face interviewed with semi structured interview. After data collection، all interviews were transcribed and reviewed and categories extracted. At first، similarity in meanings were reviewed and based on centralization arranged in a sub- category. Then with reviewing again relevant sub- categories arranged in a category. In general، original categories in the palliative care of pain in cancer context encompass; palliation of physical pain and palliation of psychological pain. Palliation of physical pain has 2 sub- categories consist of providing to mental readiness and pain palliation with drug administration. Also psychological pain has 2 sub- categories consist of supportive behavior and stress reduction. Content analysis of palliative care of pain in cancer revealed the required conditions for palliative care of pain in cancer based on perception of nurses.

Aim and Becker’s muscular dystrophy (BMD) is similar to the Duchenne’s muscular dystrophy، but the clinical course is milder. We introduced a patient with Becker Muscle Dystrophy who candidate for emergency cesarean section. Case report: A36-year-old woman، gestational age 31 weeks، with a history of Becker Muscle Dystrophy and fetal distress who candidate for emergency cesarean section. Spinal anesthesia was performed with bupivacaine 12 mg. During operation non-invasive ventilation with CPAP = 10cmH2O was started due to reduced arterial oxygen saturation. Blood pressure and heart rate did not significantly change during the surgery and recovery. We recommend spinal anesthesia with bupivacaine for cesarean section in a patient with Becker muscular dystrophy.